Methods of fixating tissue to bone

ABSTRACT

A drill pin and a method of fixating tissue to bone is described herein. A method of fixating tissue to a bone with a fixation button is described that includes advancing a drill pin from a first surface of a bone to a second surface of the bone to form a tunnel.

BACKGROUND

The present disclosure generally relates to surgical procedures and,more particularly, to methods and systems for ligament repair andreconstruction with suture and/or graft passage.

A typical ligament repair and reconstruction operation involves drillinga tunnel through a bone using a guide pin (also referred to herein as a“drill pin”) having a suture-passing mechanism. The guide pin can beused as a guide for a cannulated reamer that can be placed over theguide pin to drill a graft socket in the bone. The ligament repair andreconstruction operation can also involve implanting a suspensoryfixation button to facilitate graft attachment to the bone. Fixationbuttons can be used for fixation of bone to bone or soft tissue to bone,and the buttons are intended as fixation posts, a distribution bridge,or for distributing suture tension over areas of ligament or tendonrepair. In an example, the ligament repair and reconstruction operationis an anterior cruciate ligament (ACL) and/or posterior cruciateligament (PCL) repair and reconstruction.

SUMMARY

In typical ligament repair and reconstruction operations, the ligamentrepair and reconstruction operation involves the guide pin pulling thefixation button through the area drilled by the guide pin and pullingthe graft into the graft socket. However, the fixation button typicallyhas a width larger in size than the diameter of the tunnel formed by theguide pin, in order to provide a large enough footprint for acting as afixation post, a distribution bridge, or for distributing suture tensionover areas of ligament or tendon repair. For instance, fixation buttonscommonly used during ligament repair and reconstruction operations havea width of 3.4 millimeters (mm) or higher. As a particular example,Arthrex Inc. of Naples, Fla. provides a TightRope® Attachable ButtonSystem (ABS) having a fixation button with a 3.4 mm width and an 11 mmlength. As another example, Arthrex Inc. provides a TightRope® ABSOblong button having a 3.4 mm width and a 13 mm length. In order toinstall these fixation buttons that have a width of 3.4 mm or higher,surgeons typically drill a 4 mm or larger tunnel. However, existingguide pins for ligament repair and reconstruction operations formtunnels substantially less than 4 mm in diameter. Since existing guidepins for ligament repair and reconstruction operations form tunnels lessthan 4 mm in diameter, a surgeon typically needs to over drill the guidepin as a second step to accommodate the larger size of the fixationbutton.

The ligament repair and reconstruction operation can also involvemeasurement of tunnel depth during the operation. This measured tunneldepth can be used when determining the size of and drilling the graftsocket. Typically, in order to measure tunnel depth, the guide pin isremoved from the drilled tunnel, and then a separate measurementinstrument is inserted in order to measure tunnel depth. Alternatively,existing guide pins can have markings along the drill pin to facilitatemeasurement of tunnel depth during the operation. However, it isdifficult for a surgeon to precisely align existing guide pins with theopening of the tunnel in order to obtain a precise measurement of thetunnel depth.

The methods and systems in accordance with the present disclosurebeneficially provide improved methods and systems for fixating tissue toa bone with a fixation button. The disclosed methods and systemseliminate the step of over drilling the guide pin as a second step toaccommodate the larger size of the fixation button. Further, inaccordance with example embodiments, the disclosed methods and systemsalso provide improved methods and systems that allow for preciselyaligning the drill pin with the opening of the tunnel in order to obtaina precise measurement of the tunnel depth.

In an example in accordance with the present disclosure, a method offixating tissue to bone with a fixation button is described. The methodincludes advancing a drill pin from a first surface of a bone to asecond surface of the bone to form a tunnel. The drill pin includes (a)a flexible shaft having a first outer diameter, (b) an eyelet for suturepassing located on the flexible shaft, (c) an oversized drill tiplocated at a distal end of the flexible shaft and comprising at leastone flute, wherein the oversized drill tip has a second outer diameterthat is at least 1.5 times the first outer diameter, and (d) markingsalong the flexible shaft to allow measurement of a distance from theoversized drill tip. The method can further include positioning theoversized drill tip against the second surface of the bone anddetermining a depth of the tunnel based on the markings along theflexible shaft. The method can also include advancing a cannulatedreamer over the flexible shaft of the drill pin to form a tissue sockethaving a diameter greater than the second outer diameter and a lengthless than the determined tunnel depth and attaching a fixation buttonand tissue to the drill pin using passing sutures attached to theeyelet. The fixation button has a width that is greater than the firstouter diameter of the flexible shaft but less than the second outerdiameter of the oversized drill tip. The method then includes advancingthe eyelet through the tunnel and tissue socket, so as to move thefixation button through the tunnel and to move the tissue into thesocket, and fixating the tissue to the socket with the fixation button.

In another example in accordance with the present disclosure, a methodof fixating a tissue to bone with a fixation button is described. Themethod includes advancing a drill pin from a first surface of a bone toa second surface of the bone to form a tunnel. The drill pin includes(a) a shaft having a proximal end and a distal end, wherein the shafthas a first outer diameter of approximately 2.4 mm, (b) an eyelet forsuture passing located at the proximal end of the shaft, and (c) anoversized drill tip located at the distal end of the shaft andcomprising at least one flute, wherein the oversized drill tip has asecond outer diameter of approximately 4 mm or higher. The method alsoincludes advancing a cannulated reamer over the shaft of the drill pinto form a tissue socket and attaching a fixation button and tissue tothe drill pin using passing sutures attached to the eyelet, wherein thefixation button has a width that is approximately 3.4 mm or higher. Themethod then includes advancing the eyelet through the tunnel and tissuesocket, so as to move the fixation button through the tunnel and to movethe tissue into the socket, and fixating the tissue to the bone with thefixation button.

In another example in accordance with the present disclosure, a methodof fixating a tissue to bone with a fixation button is described. Themethod includes advancing a drill pin from a first surface of a bone toa second surface of the bone to form a tunnel. The drill pin includes(a) a flexible shaft having a first outer diameter, (b) an eyelet forsuture passing located on the flexible shaft, (c) an oversized drill tiplocated at a distal end of the flexible shaft and comprising at leastone flute, wherein the oversized drill tip has a second outer diameterthat is at least about 1.25 to about 1.75 times the first outerdiameter, and (d) markings along the flexible shaft to allow measurementof a distance from the oversized drill tip. The method can furtherinclude positioning the oversized drill tip against the second surfaceof the bone and determining a depth of the tunnel based on the markingsalong the flexible shaft. The method can also include advancing acannulated reamer over the flexible shaft of the drill pin to form atissue socket having a diameter greater than the second outer diameterand a length less than the determined tunnel depth and attaching afixation button and tissue to the drill pin using passing suturesattached to the eyelet. The fixation button has a width that is greaterthan the first outer diameter of the flexible shaft but less than thesecond outer diameter of the oversized drill tip. The method can alsoinclude advancing the eyelet through the tunnel and tissue socket, so asto move the fixation button through the tunnel and to move the tissueinto the socket, and fixating the tissue to the socket with the fixationbutton.

The features, functions, and advantages that have been discussed can beachieved independently in various embodiments or may be combined in yetother embodiments further details of which can be seen with reference tothe following description and drawings.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1a-b illustrate side views of an example drill pin, according toan example embodiment.

FIG. 2a illustrates a side view of the oversized drill tip of the drillpin of FIG. 1, according to an example embodiment.

FIG. 2b illustrates a top view of the oversized drill tip of the drillpin of FIG. 1, according to an example embodiment.

FIGS. 3-4 illustrate example fixation buttons, according to an exampleembodiment.

FIG. 5 shows a flowchart of an example method for fixating tissue to abone with a fixation button, according to an example embodiment.

FIGS. 6-14 illustrate various steps of the example method of FIG. 5 forfixating tissue to a bone with a fixation button, according to anexample embodiment.

FIG. 15 shows a flowchart of an example method for fixating tissue to abone with a fixation button, according to an example embodiment.

FIG. 16a illustrates an example curved guide that can be used with theexample drill pin of FIG. 1, according to an example embodiment.

FIG. 16b illustrates a close-up view of a tip of the curved guide ofFIG. 16a , according to an example embodiment.

FIG. 17 illustrates a perspective view of the drill pin of FIG. 1 in thecurved guide of FIG. 16a , according to an example embodiment.

DETAILED DESCRIPTION

Disclosed embodiments will now be described more fully hereinafter withreference to the accompanying drawings, in which some, but not all ofthe disclosed embodiments are shown. Indeed, several differentembodiments may be described and should not be construed as limited tothe embodiments set forth herein.

As described above, existing guide pins for ligament repair andreconstruction operations form tunnels substantially less than 4 mm indiameter. Since existing guide pins for ligament repair andreconstruction operation form tunnels substantially less than 4 mm indiameter, a surgeon typically needs to over drill the guide pin as asecond surgical step to accommodate the larger size of the fixationbutton. Further, it is difficult for a surgeon to precisely alignexisting guide pins with the opening of the tunnel in order to obtain aprecise measurement of the tunnel depth.

The methods and systems in accordance with the present disclosurebeneficially provide improved methods and systems for fixating tissue toa bone with a fixation button that eliminate the step of over drillingthe guide pin as a second step to accommodate the larger size of thefixation button. The disclosed methods and systems also provide improvedmethods and systems that allow for precisely aligning the drill pin withthe opening of the tunnel in order to obtain a precise measurement ofthe tunnel depth.

In one example, a method of fixating tissue to a bone with a fixationbutton is described. The method includes advancing a drill pin from afirst surface of a bone to a second surface of the bone to form atunnel. The drill pin includes (a) a flexible shaft having a first outerdiameter, (b) an eyelet for suture passing located on the flexibleshaft, (c) an oversized drill tip located at a distal end of theflexible shaft and comprising at least one flute, wherein the oversizeddrill tip has a second outer diameter that is at least 1.5 times thefirst outer diameter, and (d) markings along the flexible shaft to allowmeasurement of a distance from the oversized drill tip. An embodiment ofthe method further includes positioning the oversized drill tip againstthe second surface of the bone and determining a depth of the tunnelbased on the markings along the flexible shaft. An embodiment of themethod also includes advancing a cannulated reamer over the flexibleshaft of the drill pin to form a tissue socket having a diameter greaterthan the second outer diameter and a length less than the determinedtunnel depth. An embodiment of the method also includes attaching afixation button and tissue to the drill pin using passing suturesattached to the eyelet. An embodiment of the fixation button has a widththat is greater than the first outer diameter of the flexible shaft butless than the second outer diameter of the oversized drill tip. Anembodiment of the method then includes advancing the eyelet through thetunnel and tissue socket, so as to move the fixation button through thetunnel and to move the tissue into the socket, and then fixating thetissue to the socket with the fixation button.

An oversized drill tip located at a distal end of the flexible shaft andcomprises at least one flute. The term “oversized” refers to the drilltip having a second outer diameter that is larger than a first outerdiameter. In an embodiment, the second outer diameter is at least about1.1, about 1.2, about 1.25, about 1.3, about 1.4, about 1.5, about 1.6,about 1.7, about 1.75, about 1.8, about 1.9, and about 2 times largerthan the first outer diameter. In an embodiment, the second outerdiameter is about 1.1 to about 2, about 1.2 to about 2, about 1.25 toabout 2, about 1.3 to about 2, about 1.4 to about 2, about 1.5 to about2, about 1.6 to about 2, about 1.7 to 2, about 1.75 to about 2, about1.25 to about 1.75, about 1.3 to about 1.75, about 1.4 to about 1.75,about 1.5 to about 1.75, about 1.25 to about 1.7, about 1.3 to about1.7, about 1.4 to about 1.7, about 1.5 to about 1.7, about 1.25 to about1.6, about 1.3 to about 1.6, about 1.4 to about 1.6, about 1.5 to about1.6 times, about 1.25 to about 1.5, about 1.3 to about 1.5, about 1.4 toabout 1.5, about 1.5 to about 1.8, about 1.5 to about 1.9, about 1.4 toabout 1.6, about 1.4 to about 1.8, or about 1.4 to about 1.9 timeslarger than the first outer diameter. In an embodiment, an oversizeddrill tip comprises a) a first outer diameter of about 1.5 mm, about1.75 mm, about 2 mm, about 2.1 mm, about 2.2 mm, about 2.25 mm, about2.3 mm, about 2.4 mm, about 2.5 mm, about 2.6 mm, about 2.7 mm, about2.75 mm, about 2.8 mm, about 2.9 mm, or about 3 mm; and b) a secondouter diameter of about 2.7 mm, about 2.8 mm, about 2.9 mm, about 3 mm,about 3.25 mm, about 3.5 mm, about 3.75 mm, about 4 mm, about 4.5 mm, orabout 5 mm. In an embodiment, the second outer diameter is of a size toallow passage of a fixation device without overdrilling. The term“overdrilling” refers to increasing the size of a bone tunnel bydrilling with a cannulated reamer over a drill pin.

Referring now to FIGS. 1a-b , an example drill pin 100 for drilling atunnel through a bone and for suture passing is illustrated. FIG. 1aillustrates a first side view of the drill pin 100, and FIG. 1billustrates a second side view of the drill pin 100 where the drill pinis rotated about 90 degrees from the orientation shown in FIG. 1 a.

The drill pin 100 has a distal end 102 and a proximal end 104. Drill pin100 includes a flexible shaft 106 having a first outer width or diameter108. The drill pin 100 also includes an eyelet 110 for suture passinglocated on the flexible shaft 106. The drill pin 100 further includes anoversized drill tip 112 located at a distal end 114 of the flexibleshaft 106. The oversized drill tip 112 includes at least one flute 116(see FIG. 1b ), and the oversized drill tip 112 has a second outer widthor diameter 118 (see FIG. 1a ). In an example, the drill pin 100 is anun-cannulated drill pin.

In an example embodiment, the width of the oversized drill tip 112 issubstantially larger than the width of the flexible shaft 106. Inparticular, second outer diameter 118 is substantially larger than thefirst outer diameter 108. As used herein, a given diameter issubstantially larger than another diameter when the given diameter is atleast 1.5 times the other diameter. Therefore, in an example embodiment,the second outer diameter 118 is at least 1.5 times the first outerdiameter 108. In a particular example, the first outer diameter 108 isapproximately 2.4 mm and the second outer diameter 118 is approximately4 mm. In another example embodiment, the width of the oversized drilltip 112 is at least 1.25 times the first outer diameter 108. In aparticular example, the first outer diameter 108 is approximately 2.7 mmand the second outer diameter 118 is approximately 4 mm.

The drill pin 100 also includes markings 120 along the flexible shaft106 to allow measurement of a distance from the oversized drill tip 112.In an example, the markings 120 are laser markings along the flexibleshaft 106 that identify mm between 1-20 mm along the flexible shaft 106.However, in other examples, different measurement scales and more orfewer markings are possible. For instance, in another example, themarkings 120 also identify half mm. Other examples are possible as well.

The eyelet 110 can be any suitable eyelet for passing sutures (e.g.,flexible strands) or passing members from a fixation button. In theexample shown in FIGS. 1a-b , the eyelet 110 is a slot formed integralwith the flexible shaft 106. However, in another example, the eyelet 110comprises a wire loop crimped to the proximal end 104 of the drill pin100.

In an example, oversized drill tip 112 is a substantially cylindricaldrill tip comprising a cutting edge having three flats spacedapproximately 120 degrees apart with flutes. FIG. 2a illustrates a sideview of the oversized drill tip 112 and FIG. 2b illustrates a top viewof the oversized drill tip 112. As seen in FIGS. 2a-b , the oversizeddrill head 112 has a substantially cylindrical profile 130 with threeflutes 116 a-c cut out of the substantially cylindrical profile 130. Thecenters of the flats 117 a-c are spaced approximately 120 degrees apartfrom one another, as seen in FIG. 2b . The flutes 116 a-c allow fordrilled material (e.g., bone or tissue) to move back into the tunnelduring the drilling process. Further, the substantially cylindricalprofile 130 with flutes 116 a-c allow the second outer diameter 118 ofthe oversized drill tip 112 to be substantially larger than the firstouter diameter 108 of the flexible shaft 106 to which the oversizeddrill tip 112 is attached. Although the example in FIGS. 2a-b includesthree flats and three flutes, more or fewer flats and flutes arepossible as well.

In an example, the flexible shaft 106 and oversized drill tip 112 areformed from nitinol. However, other flexible materials are possible aswell, including but not limited to wound wire, plastic, carbon fiber,and flexible laser cut stainless steel. In another example, the drillpin 100 is non-flexible rather than flexible. For example, drill pin 100can be formed from non-flexible material, including but not limited tostainless steel or stainless steel tubing. Further, in an example, theshaft 106 and the drill tip 112 are formed from different materials. Forinstance, the shaft 106 can be formed from flexible material and theoversized drill tip 112 can be formed from non-flexible material. In anexample, the flexible shaft 106 is made from different flexiblematerials while the oversized drill tip 112 is made from a noncorrosivemetal.

Drill pin 100 can be used with fixation buttons during ligament repairand reconstruction procedures, such as ACL and/or PCL repair andreconstruction. FIG. 3 illustrates an example fixation button 200 forligament repair and reconstruction operations. Fixation button 200 hasan oblong configuration such that the length 202 of the fixation button200 is substantially greater than the width 204 of the fixation button200. In an example, the length 202 of the fixation button 200 is atleast 10 mm and the width 204 of the fixation button is at leastapproximately 3.4 mm. The button 200 includes at least one eyelet 206that allows for passage of a flexible strand such as the passing suture.FIG. 3 depicts two eyelets 206; however, more or fewer eyelets arepossible. In an example embodiment, the length 202 of the button isbetween approximately 10 mm and 20 mm and the width 204 is betweenapproximately 3.4 and 4 mm.

FIG. 4 illustrates another example fixation button 210 or ligamentrepair and reconstruction operations. Similar to fixation button 200,fixation button 210 has an oblong configuration such that the length 212of the fixation button 210 is substantially greater than the width 214of the fixation button 210. In an example, the length 212 of thefixation button 210 is at least 10 mm and the width 214 of the fixationbutton is at least 3.4 mm. The button 210 includes at least one eyelet216 that allows for passage of a flexible strand such as the passingsuture. FIG. 4 depicts two eyelets 216; however, more or fewer eyeletsare possible. In a particular example, the fixation button is the oblongTightRope® ABS Button (AR-1588 TB-2), measuring 3.4 mm×13 mm, providedby Arthrex, Inc. of Naples, Fla. However, other fixation buttons arepossible as well.

In order to install such fixation buttons 200, 210 having a width 3.4 mmor higher using existing drill pins, it is necessary to over drill thetunnel formed by the drill pin as a second operation, so as to create atunnel large enough to accommodate the fixation buttons 200, 210.Beneficially, the disclosed methods and systems can be used to drill atunnel having a size large enough to install fixation buttons such asfixation buttons 200, 210 without over drilling the tunnel. Therefore,the disclosed methods and systems beneficially provide a less complexand more efficient method for fixating tissue to bone with a fixationbutton.

FIG. 5 shows a flowchart of an example method 300 for fixating tissue toa bone with a fixation button, according to an example embodiment.Method 300 shown in FIG. 5 presents an embodiment of a method that, forexample, could be used with the drill pin 100 and fixation button 200 or210 shown in FIGS. 1a -4, for example. It should be understood that forthis and other processes and methods disclosed herein, the flowchartshows functionality and operation of one possible implementation ofpresent embodiments. Alternative implementations are included within thescope of the example embodiments of the present disclosure in whichfunctions can be executed out of order from that shown or discussed,including substantially concurrent or in reverse order, depending on thefunctionality involved, as would be understood by those reasonablyskilled in the art.

As shown in FIG. 5, at block 302, the example method 300 involvesadvancing a drill pin from a first surface of a bone to a second surfaceof the bone to form a tunnel. The example method then involves, at block304, positioning the oversized drill tip against the second surface ofthe bone and determining a depth of the tunnel based on the markingsalong the flexible shaft. Further, the example method involves, at block306, advancing a cannulated reamer over the flexible shaft of the drillpin to form a tissue socket having a diameter greater than the secondouter diameter and a length less than the determined tunnel depth. Stillfurther, the example method involves, at block 308, attaching a fixationbutton and tissue to the drill pin using passing sutures attached to theeyelet, wherein the fixation button has a width that is greater orsubstantially greater than the first outer diameter of the flexibleshaft but less than the second outer diameter of the oversized drilltip. Yet still further, the method involves, at block 310, advancing theeyelet through the tunnel and tissue socket, so as to move the fixationbutton through the tunnel and to move the tissue into the socket. Andyet still further, the method involves, at block 312, fixating thetissue to the socket with the fixation button. In an example embodiment,method 300 is carried out during an ACL and/or PCL reconstruction.However, other example operations in which method 300 can be carried outare possible as well.

Example method 300 is described in further detail with reference toFIGS. 6-14. As seen in FIG. 6, example method 300 involves advancingdrill pin 100 from a first surface 320 of a bone 322 to a second surface324 of the bone 322 to form a tunnel 326. Due to the oversized drill tip112, the tunnel 326 has a diameter that is substantially greater thanthe diameter 108 of the flexible shaft 106, in order to accommodate thefixation button 200 or 210. In a particular example, the diameter of thetunnel 326 is at least approximately 4 mm and the diameter 108 of theflexible shaft 108 is 2.4 mm.

The example method also involves, at block 304, positioning theoversized drill tip 112 against the second surface 324 of the bone anddetermining a depth of the tunnel 326 based on the markings 120 alongthe flexible shaft 106. The drill pin 100 is configured so that theoversized drill tip 112 can act as a positive stop during themeasurement, which beneficially helps a surgeon to both quickly andprecisely measure depth of tunnel 326. As seen in FIG. 1b , the flexibleshaft 106 includes a longitudinal axis 122. Further, a proximal end 124(see FIG. 2a ) of the oversized drill tip 112 comprises a proximalsurface 126 that is substantially perpendicular to the longitudinal axis122 of the flexible shaft 106. This substantially-perpendicular proximalsurface 126 can act as a positive stop to facilitate measurement of thedepth of the tunnel 326 formed by drill pin 100. In an exampleembodiment, positioning the oversized drill tip 112 against the secondsurface 324 of the bone 322 comprises positioning thesubstantially-perpendicular proximal surface 126 against the secondsurface 324 of the bone 322. For instance, FIG. 7 illustrates thesubstantially-perpendicular proximal surface 126 positioned against thesecond surface 324 of bone 322.

In an example embodiment, the proximal surface of the oversized drilltip 112 has a width or diameter that is substantially greater than thediameter of the flexible shaft 106. For example, the diameter of theproximal surface can be approximately 4 mm or higher, and the diameterof the flexible shaft can be approximately 2.4 mm. Further, in anexample embodiment, the proximal surface that is substantiallyperpendicular to the longitudinal axis of the flexible shaft extends atan angle between 75 and 105 degrees from the longitudinal axis of theflexible shaft. In another example embodiment, the flexible shaftextends at an angle between 80 and 100 degrees from the longitudinalaxis of the flexible shaft. In yet another example embodiment, theflexible shaft extends at an angle between 85 and 95 degrees from thelongitudinal axis of the flexible shaft. Such a substantiallyperpendicular angle allows the oversized drill tip 112 to act as apositive stop against the bone 322 and having such a positive stop canhelp to obtain a precise measurement of the tunnel depth.

In an example embodiment of method 300, step 304 is an optional step.For instance, in some example operations, step 304 can be omitted.

With reference to FIGS. 8 and 9, the method involves, at block 306,advancing a cannulated reamer 330 over the flexible shaft 106 of thedrill pin 100 to form a tissue socket 332 (see FIG. 9) having a diametergreater than the second outer diameter 118 and a length less than thedetermined tunnel depth. Cannulated reamer 330 can be a cannulatedreamer that is configured to drill over a 2.4 mm guide pin. Further, inan example, the diameter of the tissue socket 332 is between 5-8 mm, thelength of the tissue socket is approximately 20 mm or higher, and thedetermined tunnel depth is approximately 30 mm or higher. Other examplemeasurements are possible as well.

The tissue socket 332 can be used for positioning tissue during theoperation, and the tunnel 326 can be used in order to pass the fixationbutton and passing sutures beyond the second side 324 of the bone 322.With reference to FIGS. 10-11, the method also involves, at block 308,attaching fixation button 200 and tissue 334 to the drill pin 100 usingpassing sutures 336 attached to the eyelet 110. In an example, thetissue 334 is a graft, a ligament, or a tendon. In an example, the graftincludes a ligament and/or a tendon. In another example, the tissue 334is synthetic tissue.

In an example embodiment, attaching fixation button 200 and tissue 334to the drill pin 100 using passing sutures 336 attached to the eyelet110 involves attaching the fixation button 200 and the tissue 334 withsutures 338 and attaching passing sutures 336 (see FIG. 11) to thefixation button 200. After attaching passing sutures 336 to the fixationbutton 200, the passing sutures 336 are then secured to the eyelet 110(see FIG. 11).

The step of attaching the fixation button 200 and tissue 334 to thedrill pin 100 using passing sutures 336 attached to the eyelet 110 canbe performed at any suitable time. In an example, this step is performedafter the cannulated reamer 330 forms the tissue socket 332. Further, inan example, these steps are both performed without removing the drillpin 100 from the tunnel 326. Beneficially, by avoiding removing thedrill pin 100 from the tunnel 326, the overall operation time can bereduced. However, in another example, the drill pin 100 can be removedfrom the tunnel 326 in order to attach the fixation button 200 andtissue 334 to the drill pin 100. After the fixation button 200 andtissue 334 are attached to the drill pin 100, drill pin 100 can then bereinserted into the tunnel 326.

With reference to FIG. 12, the method then involves, at block 310,advancing the eyelet 110 of the drill pin 100 through the tunnel 326 andtissue socket 332, so as to move the fixation button 200 through thetunnel 326 and to move the tissue into the tissue socket 332. Asmentioned above, the tunnel 326 is at least 4 mm and the fixation button200 has a width that is greater than the first outer diameter 108 of theflexible shaft 106 but less than the second outer diameter 118 of theoversized drill tip 112. Therefore, the fixation button 200 can be movedthrough the tunnel 326 formed by drill pin 100 without over drilling ofthe tunnel 326.

With reference to FIGS. 13-14, the method then involves, at block 312,fixating the tissue 334 to the socket 334 with the fixation button 200.In an example, this involves positioning the fixation button 200 againstthe second surface 326, and then tensioning the tissue 334 so that thefixation button 200 is tightly secured to the second surface 326. Inparticular, in the example of FIGS. 13-14, the tissue 334 is firstpositioned in tissue socket 332 by moving the eyelet 110 through thetissue socket 332 and tunnel 326. After the tissue 334 is positioned intunnel socket 334, the tissue 334 is then positioned in tibial socket340. Tibial socket can be formed in a similar manner as tissue socket332. In another example, tibial socket 340 can be formed in anothermanner, such as with a retrograde reamer. The tissue 334 is thentensioned in the sockets 332 and 340, so that fixation button 200 andfixation button 342 are firmly secured to the bone.

FIG. 15 is a flowchart of a second example method 400, in accordancewith an embodiment. Note that example method 400 can be carried out by adrill pin such as drill pin 100; furthermore, example method 400 isrelated in some respects to method 300, and thus is not described in asgreat of detail. It should be explicitly noted, however, that anypossibilities and permutations described above with respect to method300 can equally apply to example method 400.

As shown in FIG. 15, example method 400 involves, at block 402,advancing a drill pin from a first surface of a bone to a second surfaceof the bone to form a tunnel. The drill pin comprises (a) a shaft havinga proximal end and a distal end, wherein the shaft has a first outerdiameter of approximately 2.4 mm, (b) an eyelet for suture passinglocated at the proximal end of the shaft, and (c) an oversized drill tiplocated at the distal end of the shaft and comprising at least oneflute, wherein the oversized drill tip has a second outer diameter ofapproximately 4 mm or higher. Example method 400 then involves, at block404, advancing a cannulated reamer over the shaft of the drill pin toform a tissue socket. Example method 400 also involves, at block 406,attaching a fixation button and tissue to the drill pin using passingsutures attached to the eyelet, wherein the fixation button has a widththat is approximately 3.4 mm or higher. Further, method 400 involves, atblock 408, advancing the eyelet through the tunnel and tissue socket, soas to move the fixation button through the tunnel and to move the tissueinto the socket. Still further, method 400 involves, at block 410,fixating the tissue to the bone with the fixation button.

In an example embodiment of example method 400, the drill pin furtherincludes markings along the shaft to allow measurement of a distancefrom the oversized drill tip, and the method 400 also involvespositioning the oversized drill tip against the second surface of thebone and determining a depth of the tunnel based on the markings alongthe shaft.

The disclosed methods and systems for fixating tissue to a bone with afixation button provide numerous advantages over existing systems andmethods for fixating tissue to a bone with a fixation button. Forexample, existing guide pins for ligament repair and reconstructionoperations form tunnels less than 4 mm in diameter and thus, it isnecessary to over drill the guide pin in order to form a tunnel largeenough to accommodate a fixation button. However, the disclosed methodsand systems provide for the ability to install a fixation button havinga 3.4 mm width or higher without over drilling the tunnel formed by thedrill pin. By avoiding over drilling of the tunnel 326 formed by thedrill pin, the overall operation time is beneficially reduced.

As another example, the disclosed methods and systems provide animproved way to measure tunnel depth that is more efficient and moreprecise than existing methods. As mentioned above, one existing methodof measuring tunnel depth involves removing the drill pin and using ameasurement instrument separate from the drill pin to measure tunneldepth. However, this method involves an additional tool and step toperform the measurement which increases the time and complexity of theoperation. In contrast, the disclosed methods and systems do not involveusing an additional measurement tool and thus can help to reduce thetime of operation. Further, as mentioned above, existing drill pins caninclude markings along the longitudinal axis of the drill pin. Althoughexisting drill pins can include laser markings along the longitudinalaxis of the drill pin, existing drill pins do not include an oversizeddrill tip that can reliably be used as a positive stop against the bone.Thus, the disclosed systems and method beneficially provide improvedmethods and system to measure the tunnel depth. This improved way tomeasure tunnel depth can help to obtain a more precise measurement oftunnel depth. Further, this improved way to measure tunnel depth canalso allow a surgeon to more efficiently perform the measurement, whichcan help to decrease the operation time.

Further, the disclosed oversized drill tip allows for providing a tipthat is configured to drill a 4 mm or larger tunnel while stillmaintaining a 2.4 mm flexible shaft. By maintaining a 2.4 mm flexibleshaft, the disclosed drill pin 100 can be used with existing cannulatedreamers to form the tunnel socket 326. Some existing drill pins includea 2.4 mm shaft and drill tip somewhat larger than 2.4 mm. For instance,some existing drill pins include spade tips that are larger than 2.4 mm.However, spade tips substantially larger than 2.4 mm that are attachedto a 2.4 mm flexible shaft are not compatible with a curved guide, asthe flat spade tip does not spin inside the cannulation of the device aswell as the disclosed oversized, substantially cylindrical, and fluteddrill tip. Therefore, the disclosed oversized, substantiallycylindrical, and fluted drill tip offers advantages over existing drillpins having spade tips.

An example curved guide is described with reference to FIGS. 16A-B and17. In particular, FIG. 16A illustrates an example curved guide 500 thatcan be used with a drill pin such as drill pin 100 during an exampleembodiment of the drilling process. The curved guide 500 includes acurved, cannulated tube 502 in which the drill pin 100 can be inserted.A distal end 504 of the cannulated tube 502 includes a recessed portion506. In an example embodiment, during use, the oversized drill tip 112sits in the recessed portion 506 at the distal end 504 of the curvedguide 500 (see FIG. 17). The oversized drill tip 112 can spin withinthis recessed portion 506. Although a curved guide is depicted in FIGS.16A-B, in other embodiments non-curved guides can also be used with thedrill pin 100. For instance, in another example embodiment, a guidehaving a straight cannulated tube may be used with the drill pin 100during an operation.

Throughout this description, the term “approximately” refers to arecited parameter or value that need not be achieved exactly, but thatdeviations or variations, including for example, tolerances,manufacturing tolerances, measurement error, measurement accuracylimitations and other factors known to skill in the art, may occur inamounts that do not preclude the effect the parameter or value wasintended to provide. For instance, as used herein, “approximately X mm”means any distance in the range of X mm+/−0.01*(X mm). Further, as usedherein, “approximately X degrees” means any degree in the range of Xdegrees+/−0.1*(X degrees).

Further, the term “substantially” refers to a recited characteristicthat need not be achieved exactly, but that deviations or variations,including for example, tolerances, measurement error, measurementaccuracy limitations and other factors known to skill in the art, mayoccur in amounts that do not preclude the effect the characteristic wasintended to provide.

Still further, although the disclosed systems and methods are describedwith reference to fixating tissue to a bone with a fixation buttonduring ACL and/or PCL reconstruction operations, it should be understoodthat disclosed systems and methods can be implemented during otherprocedures as well, including but not limited to operations for kneecollateral ligament operations, biceps tendon operations, anteriortalofibular ligament (ATFL) operations, and acromioclavicular (AC) jointoperations. The disclosed systems and methods can be used in anyoperation involving fixating bone and/or tissue to a bone with afixation button.

The description of the different advantageous arrangements has beenpresented for purposes of illustration and description, and is notintended to be exhaustive or limited to the embodiments in the formdisclosed. Many modifications and variations will be apparent to thoseof ordinary skill in the art. Further, different advantageousembodiments may describe different advantages as compared to otheradvantageous embodiments. The embodiment or embodiments selected arechosen and described in order to explain the principles of theembodiments, the practical application, and to enable others of ordinaryskill in the art to understand the disclosure for various embodimentswith various modifications as are suited to the particular usecontemplated.

What is claimed is:
 1. A method of fixating tissue to a bone with afixation button, the method comprising: (i) advancing a drill pin from afirst surface of a bone to a second surface of the bone to form atunnel, wherein the drill pin comprises (a) a flexible shaft having afirst outer diameter, (b) an eyelet for suture passing located on theflexible shaft, (c) an oversized drill tip located at a distal end ofthe flexible shaft and comprising at least one flute, wherein theoversized drill tip has a second outer diameter that is at least 1.5times the first outer diameter, and (d) markings along the flexibleshaft to allow measurement of a distance from the oversized drill tip;(ii) positioning the oversized drill tip against the second surface ofthe bone and determining a depth of the tunnel based on the markingsalong the flexible shaft; (iii) advancing a cannulated reamer over theflexible shaft of the drill pin to form a tissue socket having adiameter greater than the second outer diameter and a length less thanthe determined tunnel depth; (iv) attaching a fixation button and tissueto the drill pin using passing sutures attached to the eyelet, whereinthe fixation button has a width that is greater than the first outerdiameter of the flexible shaft but less than the second outer diameterof the oversized drill tip; (v) advancing the eyelet through the tunneland tissue socket, so as to move the fixation button through the tunneland to move the tissue into the socket; and (vi) fixating the tissue tothe socket with the fixation button.
 2. The method of claim 1, whereinthe first outer diameter is approximately 2.4 mm, wherein the secondouter diameter is approximately 4 mm or higher, and wherein the width isapproximately 3.4 mm or higher.
 3. The method of claim 1, wherein theflexible shaft and oversized drill tip comprise nitinol.
 4. The methodof claim 1, wherein the oversized drill tip is a substantiallycylindrical drill tip comprising a cutting edge having three flatsspaced approximately 120 degrees apart.
 5. The method of claim 1,wherein the flexible shaft comprises a longitudinal axis, wherein aproximal end of the oversized drill tip comprises a proximal surfacethat is substantially perpendicular to the longitudinal axis of theflexible shaft, and wherein positioning the oversized drill tip againstthe second surface of the bone comprises positioning thesubstantially-perpendicular proximal surface against the second surfaceof the bone.
 6. The method of claim 5, wherein the proximal surface thatis substantially perpendicular to the longitudinal axis of the flexibleshaft extends at an angle between 75 and 105 degrees from thelongitudinal axis of the flexible shaft.
 7. The method of claim 1,wherein attaching a fixation button and tissue to the drill pin usingpassing sutures attached to the eyelet comprises: attaching the fixationbutton and the tissue; attaching the passing sutures to the fixationbutton; and after attaching the passing sutures to the fixation button,securing the passing sutures to the eyelet.
 8. The method of claim 1,wherein the drill pin is an un-cannulated drill pin.
 9. The method ofclaim 1, wherein the eyelet is a slot formed integral with the flexibleshaft.
 10. The method of claim 1, wherein the tissue comprises aligament or a tendon.
 11. A method of fixating a tissue to a bone with afixation button, the method comprising: (i) advancing a drill pin from afirst surface of a bone to a second surface of the bone to form atunnel, wherein the drill pin comprises (a) a shaft having a proximalend and a distal end, wherein the shaft has a first outer diameter ofapproximately 2.4 mm, (b) an eyelet for suture passing located at theproximal end of the shaft, and (c) an oversized drill tip located at thedistal end of the shaft and comprising at least one flute, wherein theoversized drill tip has a second outer diameter of approximately 4 mm orhigher; (ii) advancing a cannulated reamer over the shaft of the drillpin to form a tissue socket; (iii) attaching a fixation button andtissue to the drill pin using passing sutures attached to the eyelet,wherein the fixation button has a width that is approximately 3.4 mm orhigher; (iv) advancing the eyelet through the tunnel and tissue socket,so as to move the fixation button through the tunnel and to move thetissue into the socket; and (v) fixating the tissue to the bone with thefixation button.
 12. The method of claim 11, wherein the drill pinfurther comprises markings along the shaft to allow measurement of adistance from the oversized drill tip, and wherein the method furthercomprises: positioning the oversized drill tip against the secondsurface of the bone and determining a depth of the tunnel based on themarkings along the shaft.
 13. The method of claim 12, wherein the shaftcomprises a longitudinal axis, wherein a proximal end of the oversizeddrill tip comprises a proximal surface that is substantiallyperpendicular to the longitudinal axis of the shaft, and whereinpositioning the oversized drill tip against the second surface of thebone comprises positioning the substantially-perpendicular proximalsurface against the second surface of the bone.
 14. The method of claim11, wherein the shaft and oversized drill tip comprise nitinol.
 15. Themethod of claim 11, wherein the shaft is formed from a stainless steelor stainless steel tubing.
 16. The method of claim 11, wherein theoversized drill tip is formed from a stainless steel or stainless steeltubing.
 17. The method of claim 11, wherein the oversized drill tip is asubstantially cylindrical drill tip comprising a cutting edge havingthree flats spaced approximately 120 degrees apart.
 18. The method ofclaim 17, wherein the proximal surface that is substantiallyperpendicular to the longitudinal axis of the shaft extends at an anglebetween 75 and 105 degrees from the longitudinal axis of the shaft. 19.The method of claim 11, wherein the drill pin is an un-cannulated drillpin.
 20. The method of claim 11, wherein the eyelet comprises a wireloop crimped to a proximal end of the shaft or a slot formed integralwith the shaft.
 21. A method of fixating tissue to a bone with afixation button, the method comprising: (i) advancing a drill pin from afirst surface of a bone to a second surface of the bone to form atunnel, wherein the drill pin comprises (a) a flexible shaft having afirst outer diameter, (b) an eyelet for suture passing located on theflexible shaft, (c) an oversized drill tip located at a distal end ofthe flexible shaft and comprising at least one flute, wherein theoversized drill tip has a second outer diameter that is at least about1.25 to about 1.75 times the first outer diameter, and (d) markingsalong the flexible shaft to allow measurement of a distance from theoversized drill tip; (ii) positioning the oversized drill tip againstthe second surface of the bone and determining a depth of the tunnelbased on the markings along the flexible shaft; (iii) advancing acannulated reamer over the flexible shaft of the drill pin to form atissue socket having a diameter greater than the second outer diameterand a length less than the determined tunnel depth; (iv) attaching afixation button and tissue to the drill pin using passing suturesattached to the eyelet, wherein the fixation button has a width that isgreater than the first outer diameter of the flexible shaft but lessthan the second outer diameter of the oversized drill tip; (v) advancingthe eyelet through the tunnel and tissue socket, so as to move thefixation button through the tunnel and to move the tissue into thesocket; and (vi) fixating the tissue to the socket with the fixationbutton.